| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2609 |
Custom fabricate w/c cushion |
1,342 |
1,168 |
$1.08M |
| E1161 |
Manual adult wc w tiltinspac |
486 |
436 |
$816K |
| E1007 |
Pwr seat combo w/shear |
95 |
67 |
$636K |
| E1028 |
W/c manual swingaway |
2,316 |
1,838 |
$630K |
| K0005 |
Ultralightweight wheelchair |
363 |
324 |
$602K |
| K0108 |
W/c component-accessory nos |
1,445 |
1,111 |
$468K |
| E0973 |
W/ch access det adj armrest |
1,468 |
1,224 |
$271K |
| E0955 |
Cushioned headrest |
1,689 |
1,437 |
$232K |
| E2311 |
Electro connect btw 2 sys |
119 |
84 |
$220K |
| K0040 |
Adjustable angle footplate |
1,899 |
1,549 |
$218K |
| E2620 |
Wc planar back cush wd <22in |
403 |
356 |
$182K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
39 |
25 |
$172K |
| E2617 |
Custom fab w/c back cushion |
212 |
195 |
$150K |
| E0956 |
W/c lateral trunk/hip suppor |
710 |
558 |
$112K |
| E0971 |
Wheelchair anti-tipping devi |
1,230 |
1,037 |
$90K |
| E1012 |
Ctr mount pwr elev leg rest |
36 |
26 |
$58K |
| E0990 |
Wheelchair elevating leg res |
314 |
263 |
$55K |
| E2377 |
Expandable controller, initl |
139 |
100 |
$52K |
| E1002 |
Pwr seat tilt |
15 |
15 |
$48K |
| E2313 |
Pwc harness, expand control |
137 |
99 |
$40K |
| E0951 |
Loop heel |
1,153 |
977 |
$33K |
| E2203 |
Frame depth less than 22 in |
76 |
65 |
$30K |
| E2231 |
Solid seat support base |
220 |
191 |
$30K |
| E2359 |
Gr34 sealed leadacid battery |
88 |
57 |
$28K |
| E1225 |
Manual semi-reclining back |
37 |
37 |
$16K |
| K0739 |
Repair/svc dme non-oxygen eq |
312 |
272 |
$13K |
| E2310 |
Electro connect btw control |
13 |
13 |
$11K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
26 |
24 |
$9K |
| E0978 |
W/c acc,saf belt pelv strap |
139 |
116 |
$5K |